ABSTRACT
Aggressive non-Hodgkin lymphoma (NHL) is among the most common cancers in sub-Saharan Africa (SSA), where CHOP is standard treatment and outcomes are poor. To address this, we treated 17 newly diagnosed adult patients in Malawi with Burkitt (n = 8), plasmablastic (n = 8), and primary effusion lymphoma (n = 1) with a modified EPOCH regimen between 2016 and 2019. Twelve patients (71%) were male and the median age was 40 years (range 16-63). Eleven (65%) were HIV infected, median CD4 count was 218 cells/µL (range 9-460), and nine (82%) had suppressed HIV RNA < 400 copies/mL. Patients received a median of six cycles (range 2-8) and median follow-up was 14 months (range 2-34) among patients still alive. Grade 3/4 neutropenia was observed in 26% of cycles and in 65% of patients. Sixteen (94%) responded to EPOCH and 10 (59%) achieved a complete response. One-year overall survival (OS) was 62% (95% confidence interval [CI], 42%-91%). Five patients (29%) died from progressive NHL and three (18%) from treatment-related complications. These data suggest EPOCH with setting-appropriate modifications may be a practical, safe, and effective option for improving high-risk NHL outcomes in Malawi and comparable settings, which deserves further prospective evaluation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , HIV Infections/epidemiology , Lymphoma, Non-Hodgkin/drug therapy , Neutropenia/epidemiology , Adolescent , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , CD4 Lymphocyte Count , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Female , Follow-Up Studies , HIV Infections/blood , HIV Infections/complications , Humans , Lymphoma, Non-Hodgkin/blood , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/mortality , Malawi/epidemiology , Male , Middle Aged , Neutropenia/chemically induced , Prednisone/administration & dosage , Prednisone/adverse effects , Progression-Free Survival , RNA, Viral/blood , Vincristine/administration & dosage , Vincristine/adverse effects , Young AdultSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Castleman Disease/mortality , HIV Infections/complications , HIV/isolation & purification , Adult , Anti-Retroviral Agents , Case-Control Studies , Castleman Disease/drug therapy , Castleman Disease/epidemiology , Castleman Disease/virology , Drug Therapy, Combination , Female , Follow-Up Studies , HIV/drug effects , HIV Infections/drug therapy , HIV Infections/virology , Humans , Malawi/epidemiology , Male , Middle Aged , Prognosis , Prospective Studies , Survival RateABSTRACT
Outcomes for diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa (SSA) are poorly described. We report mature data from one of the first prospective SSA cohorts. Patients aged ≥18 years with DLBCL were enrolled in Malawi 2013-2017. Participants were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and concurrent antiretroviral therapy (ART) if positive for human immunodeficiency virus (HIV+). Eighty-six participants (mean age 47 years, standard deviation 13) were enrolled: 54 (63%) were male and 51 (59%) were HIV+, of whom 34 (67%) were on ART at DLBCL diagnosis. Median CD4 count was 0·113 cells × 109 /l (interquartile range [IQR] 0·062-0·227) and 25 (49%) had HIV viral load <400 copies/µl. Participants received median six cycles CHOP (IQR 4-6). No patients were lost to follow-up and the 2-year overall survival was 38% (95% confidence interval 28-49). In multivariable analyses, Eastern Cooperative Oncology Group performance status (PS) ≥2 and lactate dehydrogenase (LDH) >2× upper limit of normal (ULN) were associated with mortality. HIV status was not associated with mortality. A simplified prognostic model of LDH >2× ULN and PS ≥2 performed at least as well as the age-adjusted International Prognostic Index. DLBCL can be successfully treated in SSA and outcomes did not differ by HIV status. A simplified prognostic model prognosticates well and may be easier to use in resource-limited settings but requires validation.
Subject(s)
Anti-Retroviral Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , HIV Seropositivity , HIV-1 , Lymphoma, Large B-Cell, Diffuse , Adult , Aged , Cyclophosphamide/administration & dosage , Disease-Free Survival , Doxorubicin/administration & dosage , HIV Seropositivity/diagnosis , HIV Seropositivity/drug therapy , HIV Seropositivity/mortality , Humans , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/mortality , Malawi/epidemiology , Middle Aged , Prednisone/administration & dosage , Prospective Studies , Survival Rate , Vincristine/administration & dosageABSTRACT
Plasmablastic lymphoma (PBL) clinical descriptions are scarce from sub-Saharan Africa (SSA) where both HIV and EBV are highly endemic. We identified 12 patients with pathologically confirmed PBL from a prospective cohort in Lilongwe, Malawi. Median age was 46 (range 26-71), seven (58%) were male, and six (50%) were HIV-positive. Eight patients were treated with CHOP and four with a modified EPOCH regimen. One-year overall survival was 56% (95% CI 24-79%), without clear differences based on HIV status. PBL occurs in Malawi in HIV-positive and HIV-negative individuals and can be treated successfully with curative intent, even in a low-resource setting in SSA.
